Shahbar Alaa, Noor Afnan, Hakami Alqassem Y, Alhazmi Abdulfattah Y, Albeirouti Bassim, Althubaiti Raghad, Alolasi Khalid O, Almazmumi Mohammed, Alhamdan Faisal A, Albariqi Rawan A, Alnuhait Mohammed
Pharmaceutical Practices Department, College of Pharmacy, Umm Al-Qura University, Makkah 24382, Saudi Arabia.
Pharmaceutical Care Department, King Faisal Specialist Hospital & Research Center, Jeddah 22234, Saudi Arabia.
J Clin Med. 2025 Apr 16;14(8):2752. doi: 10.3390/jcm14082752.
Cancer patients are at a heightened risk of veous thromboembolism (VTE) and bleeding complications. Direct oral anticoagulants (DOACs) are increasingly used due to their oral administration and lack of routine monitoring. However, factors such as drug interactions, chemotherapy, tumor location, and renal function may influence their safety and efficacy. This study evaluates clinical predictors of VTE recurrence and bleeding outcomes in cancer patients on DOAC therapy. A multicenter retrospective cohort study included 160 adult cancer patients treated with DOACs for VTE. Data on demographics, clinical characteristics, and outcomes-including VTE recurrence, major bleeding, minor bleeding, and clinically relevant non-major bleeding (CRNMB)-were analyzed. Logistic regression identified predictors of outcomes, with significance set at < 0.05. At six months, VTE recurrence occurred in 7.5% of patients, while major bleeding and CRNMB were observed in 6.3% and minor bleeding in 8.8%. Decreased creatinine clearance (OR = 0.957, = 0.024) and dexamethasone use (OR = 18.03, = 0.031) were significant predictors of major bleeding. NSAID use (OR = 12.37, = 0.009) increased CRNMB risk. Major bleeding at 12 months was significantly associated with recurrent VTE (χ(1, N = 160) = 10.03, = 0.002). DOACs are effective for VTE in cancer patients, but careful monitoring of renal function and dexamethasone use is essential due to increased bleeding risk. Caution is advised with NSAIDs in this population.
癌症患者发生静脉血栓栓塞（VTE）和出血并发症的风险较高。直接口服抗凝剂（DOACs）因其口服给药且无需常规监测而被越来越多地使用。然而，药物相互作用、化疗、肿瘤位置和肾功能等因素可能会影响其安全性和有效性。本研究评估了接受DOAC治疗的癌症患者VTE复发和出血结局的临床预测因素。一项多中心回顾性队列研究纳入了160例接受DOACs治疗VTE的成年癌症患者。分析了人口统计学、临床特征和结局数据，包括VTE复发、大出血、小出血和临床相关非大出血（CRNMB）。逻辑回归确定了结局的预测因素，显著性设定为<0.05。在6个月时，7.5%的患者发生VTE复发，6.3%的患者出现大出血，8.8%的患者出现小出血。肌酐清除率降低（OR = 0.957， = 0.024）和使用地塞米松（OR = 18.03， = 0.031）是大出血的显著预测因素。使用非甾体抗炎药（NSAID）（OR = 12.37， = 0.009）会增加CRNMB风险。12个月时的大出血与VTE复发显著相关（χ(1, N = 160) = 10.03， = 0.002）。DOACs对癌症患者的VTE有效，但由于出血风险增加，必须仔细监测肾功能和地塞米松的使用情况。建议对该人群谨慎使用NSAIDs。
